WA HB1881

Requires parties to health care mergers, acquisitions, or contracting affiliations involving hospitals, hospital systems, or provider organizations to submit written notice to the Attorney General and Health Care Authority at least 90 days before the transaction effective date

Prohibits material change transactions that would detrimentally affect accessible, affordable health care in Washington for at least five years, requiring communities maintain same or greater access to emergency, primary, specialty, behavioral, reproductive, gender-affirming, and end-of-life care

Establishes a two-tier review process: preliminary review by the Health Care Authority within 60 days, followed by comprehensive review with public hearings for transactions that may not meet requirements; Attorney General makes final approval, conditional approval, or denial decision

Authorizes civil penalties of up to 10% of transaction value for failure to provide required notice, and up to 1% of transaction value per day for noncompliance with Attorney General orders during the five-year post-transaction monitoring period

Takes effect January 1, 2026, and does not apply to transactions with letters of intent signed before that date